ผลของการดูแลผู้ป่วยโดยมีเภสัชกรเป็นผู้จัดการรายกรณี ต่อการชะลอการเสื่อมของไตในผู้ป่วยโรคไตเรื้อรัง

Abstract

The main objective of this study was to examine the effect of pharmaceutical care program on both clinical and process outcomes in patients with stage 3 or 4 chronic kidney disease. The study was conducted between November 2021 to July 2022. Total 124 patients were enrolled and separated to intervention group (Structure Care, N = 62) and control group (Usual Care, N = 62). The intervention program (case management) consisted of finding drug-related problems, adjusting dosage, conducting patient education, and referring system for multidisciplinary teams. The outcomes were measured as clinical outcomes (blood pressure and renal function test) and process outcomes (identifying and resolving drug-related problems, knowledge score and quality of life). Paired t test, Independent t test and Repeated measure ANOVA was used to compare before/after intervention of each group and compare between group, respectively. Wilcoxon Signed Ranks test and Mann Whitney U test was used in non-normal distribution data. The study was showed that the average age of patients was 67 years old and 62% were males. Most patients had stage 3a or 3b renal failure. For clinical outcomes, the renal function (eGFR) had been significantly improved in intervention group compared to control group (Control Group: 39.77±12.66, Study Group: 45.88±11.98; p <0.05). There was no difference in SCr between group. However, SCr in intervention group was decreased while significantly increased in control group in the end of intervention (Control Group: 1.67±0.51, Study Group: 1.50±0.45; p<0.05), reflecting lower renal function. Additionally in process outcomes (quality of life, medication and disease knowledge and compliance) were significantly improved in intervention group (EQ-5D-5L: 0.817±0.061, EQ-VAS: 78.47±6.25, knowledge: 7.60 ±1.00, compliance: 66.13; p<0.001) and higher rate in detecting and solving medication problems compared to control group. This study suggested that pharmaceutical care program by using case management is an effective process to slow the deterioration rate of kidney function in patient with chronic kidney disease and improves patient’s knowledge on kidney disease and decreased drug-related problems, which is likely to slow the deterioration of the kidneys and improved clinical outcomes.